Not too long ago, we talked about the benefits of Narcan and how it can potentially save lives. The drug works by reversing overdose symptoms, giving the victim enough time to receive medical care. It has been so effective that it has even been distributed to high schools. The thought of high school students suffering opioid overdoses is scary, but it’s good to know that measures are being taken to keep them safe. Of course, not all people support Narcan (or naloxone, as it is more properly called). Some think that the existence of an overdose prevention drug actually enables users. They believe that users will be driven to use more if they know they can survive an overdose.
This doesn’t really sit right with us. First of all, most users who overdose do not do so on purpose. Perhaps some do, but this is usually an act of suicide. Giving them an overdose prevention measure that provides them a second chance at life hardly seems amoral. Second of all, naloxone itself is not new. It has actually been used for overdose reversal for close to fifty years. Considering that the opioid epidemic only began spiking a few years ago, we aren’t about to blame it on a life-saving drug.
Overdose prevention is important. And, according to a recent article by The Fix, naloxone is being used for prevention in new ways. When we first wrote about Narcan, we noted that it only worked for a short period of time. The implication was that taking it alongside opioid medication would not have much effect, as you’d have to take it every hour or so. Nonetheless, there is evidence that doctors should begin to prescribe naloxone to patients suffering from pain. Below, we’ll talk about this new study as outlined by The Fix. We’ll also enter into a discussion on whether or not this new overdose prevention method might be what we need to save lives. Remember that every life saved is a blessing. This is never a subject we should take lightly.
Details on the Overdose Prevention Study
The study in question was conducted by Dr. Phillip Coffin, who works for the Center for Public Health Research at the San Francisco Department of Public Health. As their director of substance use research, he was interested in whether or not prescribing naloxone alongside opioid medication would work as a viable overdose prevention method.
Coffin found that there was already a similar program in place, the Naloxone for Opioid Safety Evaluation. Under this program, a number of San Francisco medical facilities were co-prescribing opioid medications and naloxone. Coffin’s goal was to analyze the data in order to determine whether or not a significant level of overdose prevention had been achieved. Many of the patients participating had previously been treated for problems relating to opioid medication. Since they suffered from chronic pain, however, they were still prescribed the medications that led to these issues. It isn’t difficult to see where this could create a problem.
According to Coffin’s researchers, those prescribed naloxone generally had fewer trips to the emergency room than those who were not. This lines up with an unrelated San Francisco study on heroin overdose. In this study, it appeared that there were fewer deaths among users who had been prescribed naloxone. However, as we’re going to discuss a bit below, we should be careful about how we analyze this data. The idea of using naloxone for overdose prevention is a bit more complicated than it might appear on the surface.
In the meantime, it does appear as if Coffin’s research may have an effect on naloxone’s availability. Even our government’s executive branch has been pushing for greater availability of naloxone. In fact, this push began the year before naloxone even became FDA-approved. With research showing that co-prescribing naloxone alongside opioids could potentially result in overdose prevention, it would not be surprising if the push became stronger than ever to make naloxone more available. Overdose is responsible for more accidental deaths in the United States than any other cause. It’s only right that our nation does everything in its power to seek a solution.
Should Doctors Begin Prescribing Naloxone?
As noted above, we should be cautious when analyzing studies such as this. Every study has gaps in its research, and Coffin’s is no exception. In this case, those gaps are somewhat based on semantics—the difference between overdose reversal and overdose prevention. All we technically know is that those prescribed naloxone made fewer visits to the ER. We do not actually know whether or not they should have visited the ER. It is theoretically possible that some patients overdosed, took naloxone, and then never sought follow-up care. We shouldn’t go out of our way to assume that this happened, but we also shouldn’t ignore the possibility.
That said, it’s not too difficult to see where an overdose reversal drug might be able to achieve overdose prevention. Imagine that a doctor prescribes you opioid medication for chronic pain. They then prescribe you naloxone and say “hey, be sure to take this if your pain medication starts to kill you.” Any rational person might become a little wary of the opioids they’ve just been given. Having naloxone serves as a reminder that opioid medications are dangerous when they are abused. Some addicts will inevitably disregard the warning, but it’s believable that many would take heed.
At the end of the day, it depends on the patient. The main criticism of naloxone is that some patients will be encouraged to use more. And yes—for some, this is true. In this sense, we might compare naloxone to those little breathalyzer keychains that you can buy at the pharmacy. These are supposed to let you monitor yourself so that you do not drive drunk. But some alcoholics will inevitably push themselves to see how high they can get their BAC. And at the end of the night, many of them will still get behind the wheel.
The point is that there is no perfect solution when it comes to overdose prevention. But if naloxone prescriptions might help, we see no reason to discourage them. It takes a certain mindset for someone with a naloxone prescription to use more just so that they can justify taking it. People of this mindset are not casual users. At some point, they will likely find themselves at risk of an overdose. We should not criticize doctors for giving them a drug that could save their lives. If increasing naloxone’s availability has the potential to save even one addict from overdose, then it is worth doing.
Looking at the Future of Overdose Prevention
We have come a long way in terms of overdose prevention, but we still have quite some way to go. It always feels borderline propagandist to say that we are in the midst of an epidemic. And yet, what else could we possibly call the rise of overdose deaths over the past few years? This isn’t one of those flu strains that make headlines for months because three people died and a few more got the sniffles. Heroin and opioid medications pose a very tangible threat, and their influence over the American populace is growing at undeniable rates.
Naloxone may prove to be an effective means of overdose prevention, but that comes with a caveat. Coffin’s research only focused on patients who were prescribed opioid medications. And the study on heroin simply said that naloxone could help users survive an overdose, not prevent one from occurring. The best method of overdose prevention is abstinence from substance abuse, and naloxone may not be the tool we need to achieve this. There are some drugs, such as Vivitrol, which can help in this regard. Even so, those who really want to use will be prone to do so.
How, then, can we help? As we have mentioned before, education and awareness might be key. More people need to be made aware that the heroin and opioid epidemic is costing innocent lives. Those who are stuck in addiction need to know that there is hope for them, that there are those who care and want to help. We still need other methods of overdose prevention, and medications such as naloxone might be among them. But education must be a part of our plan if we truly wish to make any real progress.
The opioid epidemic continues to take lives, but the sunrise is just over the horizon. With medications such as naloxone and Vivitrol making strides toward overdose prevention, the fight is not yet over. Nonetheless, we must remember that the war on drugs continues. Not the war started by Nixon in the 1970s, but the one that real addicts and alcoholics are fighting every day. We can envision a future in which the trenches are no longer overwhelmed by the bodies of fallen loved ones. Naloxone has already reduced our casualties. Perhaps, through increased awareness, we can reduce them even further. No matter what the solution, we must never give up hope. The war is only over when we stop fighting. We sure won’t be stopping any time soon. Will you?